Treatment of Hypertension
Why should hypertension be treated ?
The following are the benefits of treating hypertension:-
- 50 % reduction in risk of heart failure
- 30-40% reduction of risk of strokes of brain
- 20-30 % reduction in risk of heart attacks.
The benefit occurs in all age groups including elderly. If a cause has been found (as happens in very few cases) treatment of underlying cause is useful e.g. treating kidney disease, removing adrenal tumours, stopping steroids, analgesics, contraceptive pills, certain anti depressants etc.
In the majority of cases, no cause is found. In these, we suggest non-pharmacologic ways as well as medicines to lower blood pressure.
Non-pharmacological methods may reduce blood pressure by 5- 10 mm on their own. These include
Reduction of weight if overweight
Reduction of salt in diet (avoid pickles, salted foods, preserved foods). Do not take salt substitutes if there is associated kidney disease.
Dash diet ( dietary approaches to stop hypertension diet ). Increase vegetables, whole grain cereals, low fat, low sugar and sweets, more fruits, fish and chicken if you are a non vegetarian
Increase physical activity, both physical aerobic activity and relaxation exercises may help
Stop or cut down on alcohol and smoking
Learn about Hypertension.
Pharmacological methods may reduce blood pressure
2 or more drugs are required if BP is >20/10 above the normal range. More medicines and higher doses are needed if blood pressure is due to kidney disease. These drugs may cause side effects and hence prescriptions are tailor made to suit particular requirements of the patient.
The drugs include
Diuretics : – which increase salt and water excretion in the body. These work only if salt is cut down in the diet.
ACE- inhibitors and ARB’s : -These are a class of medicines which protects against ill effects of high BP on kidneys, heart and brain. However, treatment is complicated and always should be under the guidance of a competent physician. These drugs are known to cause fetal malformations. Inform your doctor if you are pregnant or are planning to have a child,
Calcium Channel Blockers :- Very useful and often used class of drugs. Some times these may cause feet to swell otherwise these are well tolerated.
Betablockers:- These reduce heart rate and blood pressure. This is useful in reducing stress on the heart. However, these may cause serious worsening in asthma and may aggravate prostate symptoms, and may cause impotence.
Centrally acting and alfa blockers:- These are also useful in controlling BP. Some of these may cause or worsen depression.